NURSING ASSISTANT PROGRAM INFORMATION AND

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1 CENTRAL ARIZONA COLLEGE SKILLS CENTER HEALTHCARE PROGRAMS NURSING ASSISTANT PROGRAM INFORMATION AND ENROLLMENT PACKET One-Stop / Skills Center Job Skills Training Program SkillsCenter6/2008

2 Central Arizona College-Health Professions Programs at the Skills Center Nursing Assistant Program The Nursing Assistant Program (CNA) is designed to prepare students to be eligible for Nursing Assistant Certification through the Arizona State Board of Nursing and upon certification, practice in a health care agency as a certified nursing assistant and to master skills required to enter into the Central Arizona College Nursing Program. Students may apply to the Nursing Program after successful completion of the prerequisite courses and completing the admission requirements. The Central Arizona College Nursing Program Information and Application Packets are available at the college admission and/or advising offices on each campus. Students wanting to enroll in the courses at the Skills Center must attend a Skills Center CNA Orientation and/or speak with the Skills Center Manger or designee to request and receive information for enrollment into the Certified Nursing Assistant program. Upon satisfactory completion of HPM 125 Nursing Assistant course, the student is eligible to receive a certificate of completion. Each student must apply for the certificate of completion by the specific date of graduation checkout, approximately 6-8 weeks before the end of the program (Refer to the Class Schedule). Central Arizona College reserves the right to change, without notice, any costs, materials, information, curriculum, requirements, and regulations in this publication. 1

3 CNA ENROLLMENT INFORMATION Central Arizona College / Skills Center is in partnership with Arizona Workforce Connection to create a One-Stop/Skills Center where students can receive services from state job agencies and college services/classes all within one building. One of the key goals of the Skills Center is to afford students a seamless, uncomplicated process with a complete grouping of course offerings to secure employment upon completion. To foster this key goal, all program offerings at the Skills Center are arranged in cluster groupings. The cluster grouping, for the CNA program, include three additional classes: Introduction to Healthcare, Employment Readiness Program Part I and Part II. ALL costs of the cluster grouping courses at the Skills Center for the Certified Nursing Assistant program, are covered in the cost of the program, $2,315 (price is subject to change without notice). This includes tuition, loaner textbooks, student workbooks, materials, supplies, physical, and background check. Those wishing to register for the cluster grouping of courses at the Skills Center for the CNA Program must submit a Request for Enrollment form and provide documents following the outline described below. The courses, as approved by the Dean of Healthcare and Sciences, are Introduction to Healthcare, CPR for the Professional, Certified Nursing Assistant, and Employee Readiness Parts I and II. Steps to Request Enrollment: 1. Carefully read through the directions for requesting enrollment into the cluster grouping of courses for the Certified Nursing Assistant (CNA) at the Skills Center. 2. If you have questions about the process, please contact: Penny Miller, Skills Center, Program Specialist , Or MaryCecilia Gutierrez, Skills Center, Manager , 3. Complete the Request for Enrollment forms included in this packet. 4. Complete the Health and Safety Documentation Checklist and Health Care Provider Signature Form found in this packet. Students need to follow directions for submitting their health documents as described on the Health and Safety Documentation Checklist in order for their application to be considered complete. The TB skin test must be completed within the last 6 months and the CPR card within the last 12 months (CPR is one of the classes included in the cluster grouping.) Students should keep their original documents for their records. Only copies of documents should be submitted with the packet. If copies are needed, please bring originals in for copies to be made. Once the college accepts documents, documents will not be returned to students. 5. Students enrolling in the cluster grouping of courses are responsible for payment either personally or through agency referral. All of the courses are eligible for financial aid. Students are responsible for their expenses IF their referring agency does not pay for their classes. 6. Students need to take the ASSET test at the Skills Center OR obtain copies of referring agency s reading/writing tests. 2

4 7. Submit the following documents to Penny Miller or MaryCecilia Gutierrez at the Skills Center in an envelope with your name or stapled together. The following information needs to be included. a. Request for Enrollment form b. Health and Safety Documentation with all documents attached c. Health Care Provider Signature Form d. Agency reading/writing test scores if using them 8. Completed Skills Center CNA program packets will be processed in the order they are received. Students submitting all of the required documentation will be notified when they may come to the Skills Center to register. Only ten (10) students are allowed in the class at a time. Process to Enroll in the Skills Center CNA Program: Students are able to register for the class, once Request for Enrollment forms are checked by the Skills Center Manager, the Program Specialist, the Professor of the CNA class or designee to make sure all the requirements are complete. Please allow at least two (2) weeks for this process, once you have submitted all the paperwork. When all the requirements are met and space is available, the student will receive notification via e- mail, phone, and/or mail of their acceptance into the CNA class. Once students are notified, they are required to come into the Skills Center / Corporate Center to register for the class(es) due to the cluster grouping. The agreement form for student participation in the program from the referring agency should be on file with the college prior to submitting the enrollment packet. If it is not, however, then a hold may be placed on the student s enrollment until the referring agency sends the appropriate paperwork. This may prohibit you from attending the class. A waiting list will be kept (first come/first secure) and maintained for the current class and future program classes. Students not referred by an agency will initiate a contract with the Skills Center for third party billing. This allows for financial aid to pay the Center directly for tuition, materials, supplies, physical, and background check. As a reminder, space is limited; only ten (10) students per class. Students will be contacted when a future class is being held to determine if they want to enroll in that class. If they have changed their minds about the Skills Center CNA program, then their application will be destroyed (shredded). They will have to submit a new application if they change their minds at a later date. Please, do not phone the office more than once a week once you have submitted an application. It takes time to review and confirm the documents. The Skills Center will contact you by , phone, or mail to let you know if you can enroll in the CNA class. 3

5 Additional Information for Enrollment into Skills Center CNA classes: Any student not attending class or clinical on the first day will be withdrawn from the course. The Nursing Assistant courses have strict attendance policies and students are expected to attend each class session. All students registered for the Nursing Assistant course MUST OBTAIN A BACKGROUND CHECK from Verified Credentials. The website address is The background check is forwarded to the Skills Center Manager only: for placement in your Nursing Assistant file at the end of the course. Only those students who have no Discrepancy found on the check will remain in the program. Nursing Assistant Uniforms: For the clinical experience students must wear forest green scrub top, white or forest green scrub pants, and white shoes. These will be provided for you through the program. A CNA supply form will be given to you at the time of registration - please fill out this form - AND RETURN IT TO PENNY MILLER. Students who begin the Skills Center CNA cluster grouping of classes and decide not to finish the program for any reason, MUST inform their referring agency AND meet with the Skills Center Manager as well as drop class(es) through Penny Miller at the Skills Center. Students who drop the cluster grouping of courses prior to the beginning of the Certified Nursing Assistant class will have the costs prorated. Students dropping after the Certified Nursing Assistant class has started will be charged the entire Skills Center fee of $2,445. Materials needed in the classes will be handed out during the respective class. o books / workbooks / notebooks o Stethoscope / cuff o Watch with second hand o Uniform needed for clinicals o White shoes for clinicals Upon successful completion of HPM 125 students are eligible to take the examination for certification as Nursing Assistants administered under the guidelines of the Arizona State Board of Nursing. This examination is not provided through the Skills Center at Central Arizona College. It is a separate examination for certification through the Arizona State Board of Nursing and taken off-site of the college. Information as to the dates and times of the examination will be provided to students. The cost for obtaining certification is approximately $ Contact the ASBON at or

6 INFORMATION FOR STUDENTS ZERO TOLERANCE POLICY: The Central Arizona College Skills Center Nursing Assistant Program supports a Zero Tolerance Policy for the following behaviors: o Intentionally or recklessly causing physical harm to any person on the campus or at a clinical site, or intentionally or recklessly causing reasonable apprehension of such harm. o Unauthorized use or possession of any weapon or explosive device on the campus or at a clinical site. o Unauthorized use, distribution, or possession for purposes of distribution of any controlled substance or illegal drug on the center or at a clinical site. Nursing Program student engaging in this misconduct is subject to immediate dismissal from nursing classes and disciplinary action as described in the Student Handbook of the college will be taken. HEALTH DECLARATION: It is essential that nursing assistant students be able to perform a number of physical activities in the clinical portion of the program. At a minimum, students will be required to lift patients, stand for several hours at a time, and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct patient care. The clinical nursing assistant experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting patients lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to applying. All students entering the Nursing Assistant Program must meet all Health and Safety requirements to maintain enrollment status for CNA courses. Students will meet these requirements by providing all documents attached to the Skills Center, which includes the Health/Safety Requirements Documentation pages and the signed Health Declaration Form from your health care provider. BACKGROUND CHECK: All students are required to obtain a background check. Access the website by going to Only those students who have no Discrepancy found on the check will remain in the program. WAIVER OF CERTIFICATION GUARANTEE: Admission or graduation from the Central Nursing Assistant Program does not guarantee obtaining a CNA certificate. Certification requirements and the subsequent procedures are the exclusive right and responsibility of the Arizona State Board of Nursing. Students must satisfy the requirements of the Nurse Practice Act: Statutes, Rules, and Regulations, independently of any college or school requirements for graduation. Pursuant to A.R.S (B)(17), an applicant for professional or practical nurse license by examination is not eligible for licensure if the applicant has any felony convictions and has not received an absolute discharge from the sentences for all felony convictions. The absolute discharge must be received five or more years before submitting this application. If you cannot prove that the absolute discharge date is five or more years, the Board cannot consider your application. All Nursing Assistant applicants for certification and licensure will be fingerprinted to permit the Department of Public Safety to obtain state and federal criminal history information. All applicants with a positive history are investigated. If there is any question about eligibility for licensure or certification, contact the nursing education consultant at the Arizona State Board of Nursing ( ). *Fees are subject to change by the Central Arizona Community Colleges Governing Board. All costs quoted are subject to change. 5

7 REQUEST FOR ENROLLMENT INTO SKILLS CENTER CNA PROGRAM (PRINT) Name Student ID Number 880. Phone #: Day Evening Cell Mailing Address City State Zip (PRINT) Address , phone, or mail will be used to contact you about enrolling for classes. DIRECTIONS: Students need to fill out the following documents AND have their doctor or other medical personnel complete the Health Care Provider Signature Form. Submit all completed documents in an envelope or stapled together with your name on them to Penny Miller or MaryCecilia Gutierrez at the Skills Center. The documents are as follows: o Request for Enrollment Form o Health and Safety Documentation Checklist (with all documentation attached) o Health Care Provider Signature Form o Agency reading/writing test scores if using them Penny Miller will give students a CNA Supply Form to complete at the time students submit their Request for Enrollment packet. Please fill out this form immediately and return it to Penny. Enrollment requests for the cluster grouping of courses are on a first come / first secured basis; space is limited to the first ten (10) students for the actual CNA course. A waiting list will be taken and maintained for current and future CNA classes. I have completed and attached the following documentation for enrollment: Check when completed prior to handing in the packet Copies of the completed documentation required on the Health and Safety Documentation Checklist and Health Care Provider Signature Form found in this packet. Copies of your TB skin test (which must be completed within the last 6 months) Copies of your CPR card (needs to be issued within the last 12 months) (CPR course is part of cluster grouping.) Copies of your reading and writing tests scores from referring agency OR complete the ASSET/COMPASS test with the college (prior to submitting your enrollment packet). I am requesting permission for registration into the Skills Center CNA cluster grouping courses offered through the Skills Center, Job Training Program. Campus: Skills Center Class Group Date CRN#s 6

8 CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM HEALTH AND SAFETY DOCUMENTATION CHECKLIST Applicant: Date: Home Phone: Cell Phone: Student ID Number: 880. A. MMR (Measles/Rubeola, Mumps, Rubella): Requires documented proof of two MMRs in lifetime or a positive titer for each of these diseases. 1 st MMR Date: 2 nd MMR Date: OR Date & results of titer: Measles/Rubeola Mumps Rubella Circle: Yes or No I have attached documented proof as specified above. B. Varicella (Chickenpox): Requires documented proof of (2) vaccinations or positive IgG titer. 1 st Varicella Date: 2 nd Varicella Date: OR Date & results of IgG titer: Circle: Yes or No I have attached documented proof as specified above. C. Tetanus/Diphtheria (Td) immunization within the past 10 years. Td Date: Circle: Yes or No I have attached documented proof as specified above. D. Tuberculosis: Documentation of an annual TB skin test (PPD). If positive skin test, provide annual documentation of chest X-ray negative for evidence of disease, or written documentation of a TB disease free status from a licensed health care provider. All testing must have been completed within the previous six (6) months. PPD Date: Date of Reading: Results (circle): Negative OR Positive OR Chest x-ray Date: Results: Circle: Yes or No I have attached documented proof as specified above. E. Hepatitis B: Documented evidence of completed series or positive antibody titer. If beginning series, first injection must be prior to admission and the series completed within 6 months. Date of 1 st injection: OR Hep B Titer Date: Date of 2 nd injection: Titer Results: Date of 3 rd injection: Circle: Yes or No F. CPR Card: Health Care Provider Date CPR card Issued: I have attached documented proof as specified above. Expiration Date: Circle: Yes or No I have attached a copy of both sides of the CPR Card. CPR certification must have been completed within 12 months. CPR course is part of cluster grouping of courses. 7

9 CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM HEALTH AND SAFETY DOCUMENTATION CHECKLIST IMPORTANT: Students are responsible for maintaining their own health records. The Health Careers Department accepts only photocopies of all documentation of health related materials. The Health Careers Department does not retain copies of immunization records, CPR certification, nor TB skin test results in student files. Students are responsible for maintaining their own records of current CPR certification and proof of negative TB skin tests until completion of the program. Copies of proof of these updates must be submitted to the Health Careers Department when due. All immunization records must include your name, name and signature of the healthcare provider giving the immunization, and date. A health care provider s signature on the Health Declaration form, without proof of immunization status, is NOT acceptable. IMMUNIZATIONS A. MMR (measles/rubella, mumps, rubella) Options to meet this requirement: a. Attach a copy of proof of two previous MMR vaccinations to the health declaration form. OR b. If you had all three illnesses OR you have received the vaccinations but have no documented proof, you must have a titer drawn for each illness. i. If the titer results are POSITIVE, attach a copy of the results to the health declaration form. ii. If the titer results are NEGATIVE, you must get your first MMR vaccination and attach documentation to the health declaration form. The second MMR must be completed within one month and proof submitted to the nursing department. B. VARICELLA (chickenpox) Options to meet this requirement: a. Attach a copy of proof of a positive IgG titer for varicella. OR b. If the titer is NEGATIVE, attach a copy of proof to the health declaration form that you received the first vaccination. Complete the second vaccination in 4 to 8 weeks and submit proof to the nursing department. C. TETANUS/DIPHTHERIA (Td) immunization within the past 10 years. Attach a copy of proof of Td vaccination to the health declaration form. D. TUBERCULOSIS Options to meet this requirement: a. Attach a copy of proof of a TB skin test (PPD) completed within the previous 6 months and results. Records for PPD (skin testing for tuberculosis) require name and signature of the healthcare provider, and findings. OR 8

10 CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM HEALTH AND SAFETY DOCUMENTATION CHECKLIST b. If you have a POSITIVE TB skin test you must submit a copy of proof of a chest x-ray completed within the previous 6 months and its results. Provide evidence of disease free status. E. HEPATITIS B Options to meet this requirement: a. Attach a copy of proof of completion of three Hepatitis B injections to the health declaration form. HbsAB antibody titer to the health declaration form. b. If you have not received the injections in the past, you must obtain the first injection and attach a copy of proof of the injection to the health declaration form. You must receive the 2 nd injection in one month and the 3 rd five months after the second. Submit documentation to the nursing department. F. CPR Card: Must be a Health Care Provider Attach a copy of both sides of the CPR card to this form. CPR certification must include infant, child, and adult, 1 and 2 man rescuer, and evidence of a land-based demonstration component. CPR certification must have been completed within 12 months. CPR course is part of cluster grouping of courses. Instructions for Completion of Health Care Provider Signature Form A health care provider must sign Health Care Provider Signature Form and indicate whether the applicant will be able to function as a Nursing Assistant student. Health care providers who qualify to sign this declaration include a licensed physician (M.D., D.O.), a nurse practitioner, or physician s assistant. 9

11 CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM Health Care Provider Signature Form (Please Print) Applicant Name Student ID Number 880 It is essential that nursing students be able to perform a number of physical activities in the clinical portion of the program. At a minimum, students will be required to lift patients, stand for several hours at a time and perform bending activities. Students who have a chronic illness or condition must be maintained on current treatment and be able to implement direct patient care. The clinical nursing experience also places students under considerable mental and emotional stress as they undertake responsibilities and duties impacting patients lives. Students must be able to demonstrate rational and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental and physical demands of the program prior to making application. I believe the applicant WILL OR WILL NOT be able to function as a nursing student as described above. If not, explain: Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.) Print Name: Title: Signature: Date: Address: City: State: Phone: 10

12 CENTRAL ARIZONA COLLEGE SKILLS CENTER NURSING ASSISTANT PROGRAM Health Care Provider Signature Form (PRINT) Name Student ID Number 880 (PRINT) Address Campus Contact/Nursing Assistant Faculty Check (Initial for verification) This is your check off sheet to make sure you have all of the paperwork required for your packet. Checklist: Documented proof of MMR (Measles/Rubella, Mumps, Rubella) immunity or vaccination Documented proof of Varicella (Chickenpox) immunity or vaccination Documented proof of Tetanus/Diphtheria (Td) immunization within the past 10 years. Documented proof of a Tuberculosis free status within 6 months. Documented proof of Hepatitis B immunity or vaccinations. Documented proof of CPR certification within 12 months. Health Care Provider Signature Form Unofficial transcript showing scores on the ASSET or COMPASS Test Background check completed. 11

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